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SUMEKG > EKG- ALS > Flashcards

EKG- ALS Flashcards

1
Q

What is result of SVTs?

A

Dec CO and perfusion.
Tacy w/ P-T wave together.
Possible to have sudden SVT w/in NSR

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2
Q

During ventricular tachy, is the QRS pos or neg deflection?

A

Negative deflection

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3
Q

What is used to treat Polymorphic V-tach/Torsades?

A

1g IV bolus. Magnesium sulfate- regulates Ca

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4
Q

What ECG findings lead to torsades?

A

Short to long to short PRI cycle,
Prolong QT,
change in amplitude

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5
Q

What should be monitored if Torsades is present on EKG?

A

BP, Oxygen d/t DEC CO

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6
Q

What occurs when the ventricles quiver asynchronously w/o coordination, w. Rate of 250?

A

V-fib.
TX- AED STAT
dose of antirarrythmic to suppress ectopy

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7
Q

Mr. Shock has no pulse, but EKG shows NSR followed by AFib? What is this and TX?

A

Pulseless Electrical Activity- AFib+no pulse.

Tx- CPR and EPI

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8
Q

Does Vtach and Vfib have a pulse?

A

No, but not a PEA

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9
Q

This shock is used with TACHYcardia ONLY and is a burst of electricity w/ heart rhythm to avoid R on Twaves?

A

Cardioversion

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10
Q

If a Pt collapses w/o a pulse, but a rhythm is detected what is used?

A

Defibrillator- Only for Vfib, Vtach

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11
Q

Ms. Neihaus has BP 89/60, is she unstable? What other s/s?

A

ONLY if she has 1 of the following also

  • altered mental status,
  • in shock -Clammy, pale, rapid respiration, N/V, Dilated pupils, weak, syncope
  • AHF
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12
Q

What is shock with low BP and fever?

A

Sepsis

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13
Q

What may cause acute CHF?

A

Drugs, volume overload, and PE

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14
Q

Treatment for arrhythmia should be based on controlling what?

A

H/T- hypovolemia, hypoxia, H+ acidosis,Hypo/hypekalemia, hypothermia.

Ts- tensio pneumothorax, tamponande, toxins, thrombus: PE, MI

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15
Q

Mr. Sloe has a pulse of 48? What are DDX

A 
Sinus bradycardia, 
Sick sinus syndrome, 
Junctional rhythm
Idiopathic ventricular rhythm, 
AV block 2-3degr. 
CHF, MEDs
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16
Q

What would be symptoms other than pulse that may indicate Bradycardia?

A 
ECG, 
Peripheral pulses absent or weak 
cap refill increased 
skin-pale and cool
Mental-fatigue dizzy
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17
Q

Mr. Sloe is on opioids, and his heart is not perfusing, what is TX for is bradycardia?

A

Maintain airway,
ECG monitor.
ATROPINE - 0.5mg bolus-MAX 3MG. Repeat Q3-5min

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18
Q

What is atropine?

A

Class IIA antiarrythmic IDEAL for BRADYCARDIA

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19
Q

WHAT is next after 6x of atropine or MAXED out in HR <50?

A
  1. Transcutaneus pace
  2. Dopamine
  3. EPI
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20
Q

Which rhythms are treated with Caridoversion with wide QRS and tachy?

A 
Vtach,
 WPW, 
Torsades, 
SVT, 
LBBB, RBBB, 
PVC
21
Q

What narrow QRS tachy are treated with Cardioversion?

A 
SVT, 
sinus tachy, 
A.Fib, A.flutter. 
WPW, 
A. Tachy, 
MAT, 
Junctional tachy
22
Q

Mr. Shock has SVT w/pulse and is UNSTABLE, what are the cardioversion Joules?

A

QRS narrow regular- 50-100J,
narrow irregular 120-200J, 200J monophasic.
Wide regular 100J,
Wide IRReg- turn off synchronization and DEFib ASAP

23
Q

How do you treat a STABLE pt with WIDE QRS tachy w/ pulse? For ex WPW or LBBB

A

ADenosine if regular.
Antirrhythmic
Consult

24
Q

How do you treat STABLE pt with NORMAL QRS tachy w/ pulse? For SVT

A 
IV,IO 
EKG, 
Vagal/valsalva massage, 
Adenosine if regular. 
Consult
25
Q

This drug effect DEC HR and conduction velocity at AV?

A

Adenosine.

Other procainamide, amiodarone

26
Q

What evaluate CO2 perfusion during CPR?

A

Capnogram

27
Q

When should CPR be stopped in aystole PEA?

A
  1. Failure to respond
  2. time b4 collapse CPR and defib
  3. Length or resuscitation
  4. comorbid
  5. DNR
  6. Low end tidal CO2 after 20min of CPR
28
Q

What are outcomes if fluid is pushing on heart?

A

Pericardial effusion w/ tamponade- low voltage/small QRS and T wave

29
Q

ECG shows a reg QRS, then low QRS repeated, tachy. The pt has PHM of recent viral infection?

A

Cardiac Tamponade- ELECTRICAL ALTERNANS. Heart contracts harder and faster.

30
Q

Clinically what are signs of pericardial effusion known as BECK triad?

A
  1. JVD*
  2. HYPOtension
  3. Muffled sounds
    - Less CP if they lean forward.
    - SOB,
31
Q

What leads will determine low voltage of QRS-cardiac tamponade?

A 
LIMB leads<5mm, Precordial <10mm in.  Produce noise and heart compressed. Seen Normally in
 1. Obese 
2 COPD 
3. Pericardial effusion 
4. HYPOthyroid 
5. Emphysema
 6. MI damage 
7. Infiltrative/restrictive dz
32
Q

US will show what w/ cardiac tamponade?

A
  1. Pericardial fluid
  2. RV diastolic collapse
  3. Dilated IVC
33
Q

What is the first step in treatment of Adult Brady or Tachy w/ PULSE?

A
  1. Maintain airway, O2,
  2. Monitor-detect Rhythm ECG 12, BP, PO2.
  3. IV access
34
Q

If Pt is Bradycardia w/ PULSE, and sx-shock, hypotension, alter mental status, what is next?

A

1 Atropine 0.5mg, repeat 3-5min MAX 3mg. OTHer transcutaneus pacing, Dopamine- 2-20mcg/min. Epi IV 2-10mcg/min

35
Q

If TACHY w/ PULSE, and sx-shock, hypotension, alter mental status, what is next? Rhyhm is REG NARROW

A

50-100J Sync Cardioversion w/ sedation. Consider ADENOSINE- IV 6mg rapid w/ NS flush. 2nd dose 12mg prn

36
Q

What is cardioversion for NARROW IRREGULAR QRS?

A

120-200J bi, or 200J mono

37
Q

What is cardioversion for WIDE REGULAR QRS?

A

100J

38
Q

What is cardioversion for WIDE IRREGULAR QRS?

A

DEFIB, TURN OFF SYNC CARDIO- means Vfib

39
Q

If TACHY w/ PULSE, ASYMPTOMATIC with WIDE QRS? what is next?

A

IV, 12 lead ECG.

  1. Adenosine ONLY if REG AND MONOPHASIC
  2. Procainmide, Amiodorone, Sotalol 4. CONSULT
40
Q

If TACHY w/ PULSE, ASYMPTOMATIC with NARROW QRS? what is next?

A

IV, 12 lead ECG.

  1. VAGAL maneuvers
  2. CCB, BBB
  3. CONSULT
  4. Adenosine if Reg.
41
Q

WHat is procainamide dose for ADult tachy w/ WIDE QRS?

A

20-50mg/min unitl suppressed. MAX 17mg/kg. AVOID if prolonged QT or CHF

42
Q

WHat is AMIODARONE IV dose for ADult tachy w/ WIDE QRS?

A
  1. 150mg over 10min.

2. 1mg/min for first 6hrs

43
Q

WHat is SOTALOL dose for ADult tachy w/ WIDE QRS?

A
  1. 100mg 5min. AVOID if prolonged QT
44
Q

If Mr. Shock has O2 and attahced to monitor and defib, but is PEA? What is next?

A
  1. CPR 2min
  2. IV, IO
  3. EPI 1MG Q3-5min
  4. Airway-intubate, capnography
  5. Treat H/T
45
Q

If Mr. Shock goes into cardiac arrest, has O2 and attached to monitor and defib w. VFIB or VT? What is next?

A
  1. SHOCK
  2. CPR 2min w/ IV IO
  3. Shock until unshockable rhythm
  4. ADD EPI 1MG Q3-5min 5. 3- Round CPR ADD Amiodarone
46
Q

What is AMIODARONE IV dose for cardiac arrest w/ Vfib?

A

1 300mg bolus. Next Dose 150mg Bolus

47
Q

What if Mr. Shock rhytmn is not shockable?

A

If no signs of ROSC, then 1. CPR 2min IV

  1. EPI 1MGQ3-5MIN
  2. Intub and capingraphy. Repeat CPR and EPI until CALLED
48
Q

After return of spontaneuous circulation 94-99%, then what?

A

Establish IV. Fluids 1-2L Normal or LR EPI.

if SBP<90 or MAP<65. NE if very low.

SUMEKG (8 decks)

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